Healthcare Provider Details

I. General information

NPI: 1093659385
Provider Name (Legal Business Name): HAVEN HILLS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8128 NORTH BOND ST
FRESNO CA
93720
US

IV. Provider business mailing address

8128 NORTH BOND ST
FRESNO CA
93720
US

V. Phone/Fax

Practice location:
  • Phone: 559-538-3145
  • Fax: 661-310-3848
Mailing address:
  • Phone: 559-538-3145
  • Fax: 661-310-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JUSTICE OTCHERE
Title or Position: CEO
Credential:
Phone: 559-538-3145